Share This Story!

How Oregon hopes to improve stroke care

Stroke is the fourth leading cause of death in Oregon and the leading cause of disability, and while mortality rates are dropping, the disabilities stroke survivors experience can be devastating to their and their loved ones' lives.

How Oregon hopes to improve stroke care

Chances are, you have or you know of someone who has had a stroke. If not, you will eventually.

In Oregon, 2.5 percent of adults have had a stroke — 10.8 percent in people 75 years or older. Even more troubling, risks of stroke run rampant in Oregonians' lives: 28 percent of Oregon adults report having high blood pressure, 32 percent have high cholesterol and 25 percent are obese.

Stroke is the fourth leading cause of death in Oregon and the leading cause of disability, and while mortality rates are dropping, the disabilities stroke survivors experience can be devastating to their and their loved ones' lives.

The difficulty about stroke treatment is that timing is everything, and it a patient's outcomes relies on the vigilance of family members to recognize symptoms and emergency responders to get them to the hospital quickly. But even once the patient is brought to the hospital, there aren't enough stroke specialists in local communities who can quickly make the right treatment decisions for patients.

For instance, the only stroke treatment approved by the U.S. Food and Drug Administration is tPA, or tissue plasminogen activator, and it comes with high risks and high rewards if administered correctly.

If given to the right patient at the right time (within three hours from the onset of symptoms), tPA could improve the patient's chances of recovery. But if given in the wrong circumstances, the patient could experience brain bleeds and death.

So in community hospitals that don't have a stroke expert on hand, the general neurologist or emergency physician are often uncomfortable making this call, said Susie Fisher, a registered nurse and president of the Oregon Stroke Network. But stroke patients can't afford the hesitation, she said.

"Many patients end up not getting it at all because the doctors are not comfortable because they're erring on the side of caution," Fisher said.

This is among the dilemmas that a state committee newly formed to look at ways to improve stroke care hopes to alleviate. Fisher is an ad hoc member of the committee and helped get the bill creating the committee passed in the 2013 Legislature.

More generally, the committee is charged with gathering data from hospitals on a voluntary basis and identifying protocols and standards that all hospitals and emergency responders should follow. The goal is that even in smaller towns that lack the stroke expertise Portland has, patients can receive quality care.

One of the triggers for the formation of the committee occurred in 2009, when Oregon received a D in the National Report Card on the State of Emergency Medicine, said Sarah Higginbotham, Oregon government relations director for the American Stroke Association.

Among the reasons Oregon performed so poorly was that it lacked a statewide stroke care protocol that put all the essential parties on the same page.

Emergency responders and hospital emergency departments have a crucial role to play in ensuring the best outcomes for stroke patients, so the hope is that through education and access to high-level specialists, Oregonians can experience the best outcomes possible.

While hospitals and emergency care organizations could reach this goal in different ways, among the options are hooking up with a telestroke network with such Portland hospitals as Oregon Health & Science University and Providence Health. The infrastructure allows partner hospitals to connect via video conference with stroke experts who can care for patients in real time.

The Oregon Stroke Care Committee met for the first time on Friday.

The 10-member committee is appointed by the director of the Oregon Health Authority and includes hospital administrators, emergency responders, neurologists, nurses and more. It is mandated to report to the Legislature on Feb. 1 of every odd year.

Perhaps the brightest side to this situation is that 80 percent of strokes are preventable, according to to the American Stroke Association. Key factors to manage include high blood pressure, cigarette smoking, physical inactivity, obesity and diabetes.

The first step in quality stroke care is the patients' and their loved ones ability to quickly identify symptoms and call 911. The American Stroke Association recommends using the acronym FAST to memorize the signs.